Healthcare Provider Details

I. General information

NPI: 1023183092
Provider Name (Legal Business Name): KENT RILLING P.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/07/2023
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4443 LYONS RD STE 211
COCONUT CREEK FL
33073-4388
US

IV. Provider business mailing address

7611 MARBLEHEAD LN
PARKLAND FL
33067-2336
US

V. Phone/Fax

Practice location:
  • Phone: 954-405-0501
  • Fax: 954-301-8501
Mailing address:
  • Phone: 301-922-9166
  • Fax: 954-405-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0002135
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: